=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699213462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE LEIGH REEVES PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2017
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 INDUSTRIAL CV
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-407-3422
-----------------------------------------------------
Fax | 877-407-4329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2041 E SHILOH RD
-----------------------------------------------------
City | CORINTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38834-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-395-0080
-----------------------------------------------------
Fax | 662-396-0088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT3195
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------